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Assisting Hand Assessment (AHA)
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Supplemental: Cerebral Palsy (CP)
Short Description of Instrument
Construct measured: The Assisting Hand Assessment (AHA) measures how a child with a unilateral upper limb impairment uses his/her affected hand (assisting hand) collaboratively with the non-affected hand in bimanual play.
Generic vs. disease specific: Disease specific (unilateral impairment such as cerebral palsy, obstetric brachial plexus palsy).
Versions: There are two versions:
1) Small Kids AHA (18 months to 5 years)
2) School Kids AHA (6–12 years)
Means of administration: Videotaped recording of a 15 minute semi-structured play session.
Intended respondent: Child.
Background: The AHA is a clinical tool developed to measure how effectively the affected hand and arm is used in bimanual activities. It is administered as a fun, play session with toys and objects designed to elicit spontaneous hand use and handling of objects. It measures performance, i.e. what a child does in a natural play environment. The scale is validated on children with unilateral CP and OBPP ages 18 months to 12 years.
Comments/Special Instructions
The AHA is administered in two steps. First the therapist conducts a semi-structured videotaped play session using specific objects and play materials. Then, the clinician reviews the video and scores the assessment at a later time. Training and certification is required to administer and score this tool.
Twenty-two items are rated using a four-point rating scale (4= effective, 3= somewhat effective, 2= ineffective, and 1= does not do). Each item is scored under four headings general use, arm use, grasp and release, fine motor adjustments, and coordination and pace. Yields three possible scores: sum of scores (22–88); percentage score (0–100); conversion by Rasch analysis to logits
Administration time: 10–15 minute play session. Unspecified time required for scoring; however, scoring is complicated and Gilmore, Sakzewski& Boyd (2009) reported that it takes approximately one hour.
Strengths/Weaknesses: Can be administered quickly in a clinical setting. Requires 3 day training and certification. Uses special equipment. Scoring is complicated and time consuming.
Psychometric Properties: ICC's for interrater reliability were 0.98 to 0.97. Intrater reliability was also high (ICC of .99). ICC's for test-retest reliability were 0.99 for the small Kid's AHA, and 0.98 for the school kids AHA. The person separation reliability estimate was 0.97 which indicates sensitivity to change (303 children ages 18 months–12 years, 88% had unilateral CP, 64% were 5 years of age). Content validity – developed by experts in the field, then refined using Rasch analysis to form a unidimensional scale. Construct validity: differentiates between children with different levels of hand function and levels of impairment not related to age.
Key References:
Krumlinde-Sundholm L, Eliasson A-C. Development of the Assisting Hand Assessment: A Rasch-built Measure intended for Children with Unilateral Upper Limb Impairments. Scan J Occup Ther. 2003;10:16-26
Krumlinde-Sundholm L, Holmefur M, Kottorp A, Eliasson A-C. The Assisting Hand Assessment: Current evidence of validity, reliability and responsiveness to change. Dev Med Child Neurol. 2007;49(4):259-264.
Holmefur M, Aarts P, Hoare B, Krumlinde-Sundholm L. Test-retest and alternate forms reliability of the Assisting Hand Assessment. J Rehab Med. 2009;41:886-891.
Holmefur M, Krumlinde-Sundholm L, Eliasson AC. Interrater and intrarater reliability of the Assisting Hand Assessment. Am J Occup Ther. 2007;61(1):79-84.
Additional References:
Gilmore R, Sakzewski L, Boyd R. Upper limb activity measures for 5- to 16-year-old children with congenital hemiplegia: a systematic review. Dev Med Child Neurol. 2010;52(1):14-21.
Krumlinde-Sundholm L, Ek L, Eliasson AC. What assessments evaluate use of hands in infants? A literature review. Dev Med Child Neurol. 2015;57 Suppl 2:37-41.
Krumlinde-Sundholm L. Reporting outcomes of the Assisting Hand Assessment: what scale should be used? Dev Med Child Neurol. 2012;54(9):807-808.
Louwers A, Beelen A, Holmefur M, Krumlinde-Sundholm L. Development of the Assisting Hand Assessment for adolescents (Ad-AHA) and validation of the AHA from 18 months to 18 years. Dev Med Child Neurol. 2016, In Press.


Document last updated February 2018